title: Patients with minimal hepatic encephalopathy have poor insight into their driving skills.
abstract: OBJECTIVE
  Minimal hepatic encephalopathy (MHE) is associated with impaired driving skills. It is not clear whether patients have insight into this. The Driving Behavior Survey (DBS) is a validated self- or observer-administered questionnaire. DBS consists of a total score (maximum, 104) and an attention-related driving skills section (maximum, 40). DBS was used to compare self-assessment with observer-assessment of driving skills in cirrhotic patients tested for MHE.
  
  
  METHODS
  Forty-seven nonalcoholic cirrhotic patients and 40 controls underwent psychometric tests, DBS, and driving simulation with navigation/driving tasks. An adult familiar with the subject's driving completed the DBS independently. Simulator performances, total DBS scores, and driving skill scores were compared between/within groups (MHE+, MHE-, and controls) with respect to self-assessment and observer assessment.
  
  
  RESULTS
  Thirty-six patients were MHE+ and 11 were MHE-. MHE+ had a significantly higher simulator crash (MHE+, 3; MHE-, 1.2; controls, 1.7; P = .001) and illegal turn rate (MHE+, 1.2; MHE-, 0.3; controls, 0.1; P = .0001). Despite this worse performance, MHE+ patients rated themselves similar to MHE- patients and control groups on total (P = .28) and driving skills scores (P = .19). Observer assessment in MHE+ was significantly lower for total (P = .0001) and driving skills (P = .0001) compared with observer assessment for MHE- patients and control groups. MHE+ patients were rated significantly lower on driving skills (34 vs 37; P = .02) and trended lower in the total score (P = .08) by observers compared with self-ratings. In contrast, MHE- and control groups rated themselves similar to their observers on driving skills and total DBS scores.
  
  
  CONCLUSIONS
  MHE patients have poor insight into their driving skills. A part of the MHE patient's clinical interview should be to increase awareness of this driving impairment.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA. jasmohan.bajaj@va.gov
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
authors.forename: Kia
authors.initials: K
authors.lastname: Saeian
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hafeezullah
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Hammeke
mesh_terms: D001333:Automobile Driver Examination / Q000706:statistics & numerical data; D001334:Automobile Driving / Q000523:psychology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012647:Self-Assessment; D011795:Surveys and Questionnaires